GYNECOLOGIC
CANCER
M. D. ANDERSON
CANCER CARE
S E R I E S
Series Editors
Aman U. Buzdar, MD Ralph S. Freedman, MD, PhD
M. D. ANDERSON CANCER CARE SERIES Series Editors: Aman U. Buzdar, MD, and
Ralph S. Freedman, MD, PhD
K.K. Hunt, G.L. Robb, E.A. Strom, and N.T. Ueno, Eds., Breast Cancer F.V. Fossella, R. Komaki, and J.B. Putnam, Jr., Eds., Lung Cancer J.A. Ajani, S.A. Curley, N.A. Janjan, and P.M. Lynch, Eds.,
Gastrointestinal Cancer
K.W. Chan and R.B. Raney, Jr., Eds., Pediatric Oncology
P.J. Eifel, D.M. Gershenson, J.J. Kavanagh, and E.G. Silva, Eds., Gynecologic Cancer
Patricia J. Eifel, MD,
David M. Gershenson, MD, John J. Kavanagh, MD, and Elvio G. Silva, MD
Editors
The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Gynecologic Cancer
Foreword by Maurie Markman, MD
Patricia J. Eifel, MD David M. Gershenson, MD
Department of Radiation Oncology Department of Gynecologic Oncology The University of Texas The University of Texas
M. D. Anderson Cancer Center M. D. Anderson Cancer Center 1515 Holcombe Blvd., Unit 1202 1515 Holcombe Blvd., Unit 1362 Houston, TX 77030-4009, USA Houston, TX 77030-4009, USA John J. Kavanagh, MD Elvio G. Silva, MD
Department of Gynecologic Medical Department of Pathology
Oncology The University of Texas
The University of Texas M. D. Anderson Cancer Center M. D. Anderson Cancer Center 1515 Holcombe Blvd., Unit 85 1515 Holcombe Blvd., Unit 1364 Houston, TX 77030-4009, USA Houston, TX 77030-4009, USA
Series Editors:
Aman U. Buzdar, MD Ralph S. Freedman, MD, PhD Department of Breast Medical Department of Gynecologic Oncology
Oncology The University of Texas
The University of Texas M. D. Anderson Cancer Center M. D. Anderson Cancer Center Houston, TX 77030-4009, USA Houston, TX 77030-4009, USA
Library of Congress Cataloging-in-Publication Data
A C.I.P. Catalogue record for this book is available from the Library of Congress.
Gynecologic Cancer
ISBN-10: 0-387-28794-9 e-ISBN-10: 0-387-28796-5 ISBN-13: 978-0387-28794-2 e-ISBN-13: 978-0387-28796-6 Printed on acid-free paper.
© 2006 Springer Science+Business Media, Inc.
All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.
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Printed in the United States of America.
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DEDICATION
This book is dedicated to the memories of Dr. Felix Rutledge and Dr. Gilbert Fletcher, who together farsightedly developed the model for the multidis- ciplinary approach to gynecologic cancers, which has benefited countless patients worldwide.
FOREWORD
There is perhaps no better model of the importance of multidisciplinary interactions in the care of cancer patients than that found in the manage- ment of gynecologic malignancies. From the critical importance of pri- mary surgical cytoreduction of advanced ovarian cancer preceding the administration of cytotoxic chemotherapy to the now-standard use of cis- platin as a radiosensitizer delivered with external-beam radiation therapy in the treatment of locally advanced cervix cancer, oncologists involved in the care of gynecologic cancer patients must understand the optimal uti- lization of multiple treatment modalities.
For more than 5 decades, the gynecologic cancer program at M. D. Anderson Cancer Center has been an innovative leader in helping to establish the standards of care in this group of malignancies and in developing novel surgical, pharmacological, and radiotherapeutic approaches to improve both the survival and quality of life of women diagnosed with a gynecologic cancer.
This well-written and comprehensive text describes the current man- agement of female pelvic tumors, with chapters authored by nationally and internationally recognized senior leaders in their fields, as well as by more junior M. D. Anderson faculty who will soon be responsible for the new advances that will, without question, characterize the future of clinical research in gynecologic malignancies.
Maurie Markman, MD
Vice President for Clinical Research
The University of Texas M. D. Anderson Cancer Center
PREFACE
The treatment of gynecologic cancers has improved owing to strong mul- tidisciplinary efforts over the years. These efforts have resulted in a sharp reduction in both the incidence and mortality of invasive cervical cancer and marked improvements in early detection of the disease. Now, emphasis is being placed on fertility preservation, and options are being explored in cervical cancer as well as in other cancers where this may be possible.
The treatment of vulvar cancer, which can be quite debilitating in its advanced stages, has followed an approach similar to that of breast can- cer, where radical surgery has given way to a multimodal approach that emphasizes quality of life as well as survival.
The introduction of paclitaxel was a major development in the primary treatment of ovarian cancer. This monograph also describes the appropri- ate use of other cytotoxic drugs for the treatment of recurrence or for pal- liation. As this book goes to press, there is more cogent evidence that intraperitoneal platinum-based therapy is likely to become a part of the standard treatment in this disease. In addition to therapy advances, there have been improvements in diagnostic tools and their application in ovar- ian cancer.
We would like to acknowledge Walter Pagel, director of the Department of Scientific Publications at M. D. Anderson Cancer Center, for his role in continuing to make the M. D. Anderson Cancer Care Series a success. We would also like to thank the volume editors, Drs. David M.
Gershenson, Patricia J. Eifel, John J. Kavanagh, and Elvio G. Silva, and the authors of this first monograph on gynecologic cancer for their significant efforts to assemble what we believe will be a most useful and important resource for any physician who diagnoses and treats gynecologic cancer.
Aman U. Buzdar, MD Ralph S. Freedman, MD, PhD
PREFACE
This book represents the culmination of a process that has evolved over almost 6 decades since Felix Rutledge and Gilbert Fletcher first stepped onto the scene at M. D. Anderson Cancer Center. Their shared vision of a multidisciplinary approach to caring for gynecologic cancer patients has not only persisted to the present but has, indeed, flourished.
Gynecologic Cancer is the most recent—but not the only—work to detail the practice of gynecologic cancer care at M. D. Anderson. Proceedings of M. D. Anderson’s Clinical Conferences on Cancer focused on gynecologic cancer were published in 1962, 1969, and 1987. These books principally outlined the M. D. Anderson multidisciplinary approach to the clinical management of gynecologic malignancies. In addition, Dr. Fletcher’s Textbook of Radiotherapy, published in 1980, and a 1976 textbook authored by Dr. Rutledge, J. Taylor Wharton, and Richard Boronow—Gynecologic Oncology—further described treatment techniques and recommendations.
Over the past several years, the face of M. D. Anderson’s Gynecologic Oncology Multidisciplinary Program has changed markedly. The faculty is much larger in number and considerably more diverse. Although evidence-based medicine is the guiding principle in clinical decision making, a myriad of clinical scenarios exist for which there is no single therapeu- tic strategy. In such instances, differing viewpoints are healthy, and the wealth of experience gained from a large-volume practice is a tremendous asset. Also, the value of the peer-review process used in our Multidisciplinary Planning Conference and Clinic cannot be overesti- mated.
Of course, the treatment recommendations and practice guidelines included in this text are anchored on past clinical trial research and are continually updated as results of new trials become available. Although the clinical trial portfolio of our multidisciplinary group is ever changing and little discussed here, research-driven patient care is of critical impor- tance in advancing our mission.
Also, we would like to acknowledge and thank Dawn Chalaire, ChaRhonda Chilton, Stephanie Deming, Kim M. Dupree, Manny Gonzales, Vickie J. Williams, and Chris Yeager of the Department of Scientific Publications for editing and compiling this volume.
On behalf of all the contributors to this book, it is a pleasure to pres- ent this new work that reflects M. D. Anderson practice early in this new
millennium. And finally, we dedicate this book to all the women with gynecologic cancer who have undergone treatment at M. D. Anderson over the past 60-plus years.
David M. Gershenson, MD Patricia J. Eifel, MD John J. Kavanagh, MD Elvio G. Silva, MD
xiv Preface
CONTENTS
Foreword ix
Maurie Markman
Preface xi, xiii
Contributors xvii
Chapter 1
Multidisciplinary Care of Patients with Gynecologic Cancers 1 David M. Gershenson, MD, John J. Kavanagh, MD,
Patricia J. Eifel, MD, and Elvio G. Silva, MD Chapter 2
Prevention and Early Detection of Endometrial
and Ovarian Cancers 12
Karen H. Lu, MD Chapter 3
Preinvasive Disease of the Lower Genital Tract 20 Andrea Milbourne, MD, and Michele Follen, MD, PhD
Chapter 4
Selected Topics in Gynecologic Pathology 30
Anais Malpica, MD, Michael T. Deavers, MD, and Elvio G. Silva, MD
Chapter 5
Imaging of Gynecologic Malignancies 49
Revathy Iyer, MD Chapter 6
Contemporary Treatment of Vaginal and Vulvar Cancers 64 Patricia J. Eifel, MD, and Thomas W. Burke, MD
Chapter 7
Treatment of Early Cervical Cancer 87
Charles F. Levenback, MD
Chapter 8
Treatment of Locally Advanced Cervical Cancer 102 Anuja Jhingran, MD, Patricia J. Eifel, MD, and Pedro T. Ramirez, MD Chapter 9
Uterine Sarcomas 125
Lois M. Ramondetta, MD, Diane C. Bodurka, MD, Michael T. Deavers, MD, and Anuja Jhingran, MD Chapter 10
Treatment of Endometrial Cancer 148
Lois M. Ramondetta, MD, Thomas W. Burke, MD, Russell Broaddus, MD, PhD, and Anuja Jhingran, MD Chapter 11
Surgery for Ovarian Cancer 175
Judith K. Wolf, MD, and J. Taylor Wharton, MD Chapter 12
Chemotherapy for Epithelial Ovarian Cancer 188 Michele L. Donato, MD, Xipeng Wang, MD,
John J. Kavanagh, MD, and David M. Gershenson, MD Chapter 13
Treatment of Rare Ovarian Malignancies 207
Jubilee Brown, MD, and David M. Gershenson, MD Chapter 14
Gestational Trophoblastic Disease 226
Hui T. See, MD, Ralph S. Freedman, MD, PhD, Andrzej P. Kudelka, MD, and John J. Kavanagh, MD Chapter 15
Fertility-Sparing Options for Treatment of Women
with Gynecologic Cancers 244
Pedro T. Ramirez, MD Chapter 16
Quality of Life and Sexual Functioning 261
Diane C. Bodurka, MD, and Charlotte C. Sun, DrPH Chapter 17
Palliative Care for Gynecologic Malignancies 279 Florian Strasser, MD, ABHPM, Michael W. Bevers, MD,
and Eduardo Bruera, MD
Index 304
xvi Contents
CONTRIBUTORS
Michael W. Bevers, MD, Associate Professor, Department of Gynecologic Oncology
Diane C. Bodurka, MD, Associate Professor, Department of Gynecologic Oncology
Russell Broaddus, MD, PhD, Assistant Professor, Department of Pathology
Jubilee Brown, MD, Assistant Professor, Department of Gynecologic Oncology
Eduardo Bruera, MD, Professor and Chair, Department of Palliative Care and Rehabilitation Medicine
Thomas W. Burke, MD, Professor, Department of Gynecologic Oncology
Michael T. Deavers, MD, Associate Professor, Department of Pathology
Michele L. Donato, MD, Associate Professor, Department of Blood and Marrow Transplantation
Patricia J. Eifel, MD, Professor, Department of Radiation Oncology
Michele Follen, MD, PhD, Professor, Department of Gynecologic Oncology
Ralph S. Freedman, MD, PhD, Professor, Department of Gynecologic Oncology
David M. Gershenson, MD, Chair and Professor, Department of Gynecologic Oncology
Revathy Iyer, MD, Associate Professor, Department of Diagnostic Radiology
Anuja Jhingran, MD, Associate Professor, Department of Radiation Oncology
John J. Kavanagh, MD, Chair Ad Interim and Professor, Department of Gynecologic Medical Oncology
Andrzej P. Kudelka, MD, Associate Professor, Department of Gynecologic Medical Oncology
Charles F. Levenback, MD, Professor, Department of Gynecologic Oncology
Karen H. Lu, MD, Associate Professor, Department of Gynecologic Oncology
Anais Malpica, MD, Associate Professor, Department of Pathology
Andrea Milbourne, MD, Assistant Professor, Department of Gynecologic Oncology
Pedro T. Ramirez, MD, Assistant Professor, Department of Gynecologic Oncology
Lois M. Ramondetta, MD, Associate Professor, Department of Gynecologic Oncology
Hui T. See, MD, Postdoctoral Fellow, Department of Gynecologic Medical Oncology
Elvio G. Silva, MD, Professor, Department of Pathology
Florian Strasser, MD, ABHPM, Clinical Fellow, Department of Palliative Care and Rehabilitation Medicine
Charlotte C. Sun, DrPH, Assistant Professor, Department of Gynecologic Oncology
Xipeng Wang, MD, Postdoctoral Fellow, Department of Gynecologic Medical Oncology
xviii Contributors
J. Taylor Wharton, MD, Professor, Department of Gynecologic Oncology
Judith K. Wolf, MD, Associate Professor, Department of Gynecologic Oncology
Contributors xix
